Study says personal, policy ills underlie infant, prenatal deaths

Half of women studied had illness, no care

January 29, 2002|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

A study of Baltimore women who lost a pregnancy at five months or later, or whose baby died, found that a third of them had previously suffered a similar loss. But according to a report on the study released yesterday, many did not understand why they had lost the child, never got counseling and then got pregnant again too quickly.

The findings are from the most intensive, wide-ranging review ever of fetal and infant deaths in Baltimore. A team of physicians, nurses, social workers and others pored over the records of 204 women - representing about two-thirds of the reported fetal and infant deaths in 1998 - looking for patterns and gaps in the health care system.

The Baltimore City Perinatal Systems Review found that almost half the women had a perinatal infection like a sexually transmitted disease (STD) and that many hadn't planned or prepared for their pregnancies. Others had no prenatal care.

Underneath those broad themes, the report's authors discovered personal and policy problems. For example, many pregnant women treated for an STD often get re-infected because their male partner isn't treated.

Some women with government health insurance don't qualify for family planning coverage. And many women who lost a baby were discharged from hospitals with nothing more than a contraceptive shot.

During the past several years, the city's infant mortality rate has steadily fallen. In 2000, Baltimore posted its second-lowest infant mortality rate in history: 11.7 deaths per 1,000 live births. Still, the city's numbers are much higher than the rest of Maryland's - and are driving up the state numbers.

Most of the Baltimore women had multiple health and social complications - 27 percent had hypertension, 39 percent had used alcohol, drugs or tobacco, and some struggled with poverty or domestic violence, according to the report.

The report recommended such improvements as follow-up care for women who have experienced a loss, increased screening for infections and better insurance coverage. The program gets chunks of state and federal dollars, and it's unclear how much money organizers have to implement their recommendations.

But the program's administrators at the Baltimore City Healthy Start outreach program for at-risk families and MedChi, the Maryland State Medical Society, say they'll be tapping doctors, clinics, private agencies and other groups.